2Masoud R. Manaviat, M.D. June 2011 Aging and the eyeMasoud R. Manaviat, M.D.June 2011
3The Challenges of Aging – How older patients are different from all other patients As people age, some physiologic changes are inevitableOther changes, while not universal, are far more common than among younger peopleOlder people also face unique psycho-social challengesThese changes and challenges can lead to a variety of geriatric syndromes and issuesThese in turn can lead to poor health outcomes, functional decline, frailty, disability and dependence
4Physiologic Changes Associated with Aging Examples of universal changesDecreased night visionDecreased muscle massLoss of hair pigmentDecreased lung vital capacityDecreased heightDecreased gait speed
5Physiologic Changes Associated with Aging Examples of changes (including diseases) that are increasingly common, though not inevitable, as people ageHearing lossMacular degenerationHypertensionHeart diseaseCancerParkinson’s diseaseDementia
6Social Problems More Common with Aging Loss of incomeLoss of close familyLoss of communitySocial isolation
8The Challenges of an Aging Population – Why it matters In the 2000 US Census, 12.5% of the US population was >64By 2030, it is predicted that 20% of the US population will be >64As the elderly population increases the care needs and expenditures for that care will increaseThe geriatric workforce is not predicted to increase to meet this demand
9Sensory Impairment - Vision Visual impairment affects 20-30% of people over the age of 75.Visual impairments that occur with greater frequency as people age includeRefractive errorCataractsGlaucomaMacular degenerationDiabetic retinopathyBlindness
10Age-Dependent Changes: Physiological and Performance
14More General Aging Changes! Retina- dulls, blood vessel changesOptic Nerve- boundaries less defined, fewer capillariesMacula- little or no foveal reflex, drusen and lipofuscin deposits, pigmentation Lids- orbicularis oculi muscle weakensLacrimal Glands/Tears- production , Orbit- fat loss, enophthalmos
15Age Changes in Performance Refraction- lens and ciliary musclesResults in PresbyopiaAge 40+Acuity and ContrastDecreases after age 50Due to BrainGlare Due to lens and vitreous humorDarkPupil and Lens
16More Performance Changes! Fun stuff- Vitreous Humor?HazinessFlashing LightsMoving SpotsColorDiscrimination as cones DarkPupil and LensVisual FieldSize 1 to 3 degrees per decade
17Diseases and Syndromes Age-Related Changes:Diseases and Syndromes
29GlaucomaWhat is it?A group of eye diseases that can damage the optic nerve in the eye.Glaucoma can develop in one or both eyes.Primary open-angle glaucoma is the most common form.
30Who is at higher risk? African Americans over age 40. (continued from previous slide)Who is at higher risk?African Americans over age 40.Everyone over the age of 60, especially Mexican Americans.People with a family history of glaucoma.
31GlaucomaNormal visionSame scene as viewed by a person with glaucoma
32Glaucoma Symptoms Treatment options No early warning signs or symptoms No painLoss of side visionTreatment optionsMedications, usually eye dropsLaser or conventional surgery
33Glaucoma What can you do? People at higher risk should get a comprehensive dilated eye exam every one to two years or as instructed by your eye care professional.
35Age-Related Macular Degeneration (AMD) What is it?Common among people aged 60 or older.Can damage the macula, which is needed for sharp, detailed central vision.
36Who is at higher risk? The greatest risk factor is age. (continued from previous slide)Who is at higher risk?The greatest risk factor is age.Other risk factorsSmoking.Family history.Obesity.Race. Caucasians are more likely to lose vision from AMD.
37Age-Related Macular Degeneration (AMD) Normal visionSame scene as viewed by a person with AMD
38AMD Symptoms No pain. Blurred vision. Drusen (can only be seen by an eye care professional).
39(continued from previous slide) Treatment optionsAge-Related Eye Disease Study (AREDS) special vitamins/minerals supplement formulation.Laser surgery.Eye injections.Photodynamic therapy.
40AMD What can you do? Eat a healthy diet Don’t smoke, or stop smoking Maintain normal blood pressureMaintain a healthy weightExercise
42Diabetic Eye Disease What is it? A group of eye problems associated with diabetes.Diabetic retinopathy is a leading cause of vision loss and blindness.
43Who is at higher risk? People with diabetes. (continued from previous slide)Who is at higher risk?People with diabetes.The longer someone has diabetes, the more likely it is he or she will get diabetic retinopathy.
44Diabetic Retinopathy Normal vision Same scene as viewed by a person with diabetic retinopathy
45Diabetic Eye Disease Symptoms No early warning signs or symptomsEarly detection and timely treatment can reduce the risk of vision loss.Treatment optionsLaser treatmentSurgery
46Diabetic Eye Disease What can you do? Control your ABCs - A1C, blood pressure, and cholesterol.Take your medications as directed.Maintain a healthy weight.Exercise.Don’t smoke.Have a dilated eye exam at least once a year.
47Dry Eye What is it? The eye does not produce tears properly. Tears evaporate too quickly.Inflammation of the surface of the eye may occur along with dry eye.
48Who is at higher risk? Women often experience dry eye more than men. (continued from previous slide)Who is at higher risk?Women often experience dry eye more than men.Dry eye can occur at any age.Older adults frequently experience dryness of the eyes.
49Dry Eye Symptoms Stinging or burning of the eye. Feeling as if sand or grit is in the eye.Episodes of excess tears following dry eye periods.A stringy discharge from the eye.Pain and redness of the eye.Episodes of blurred vision.
50Symptoms Heavy eyelids. (continued from previous slide)SymptomsHeavy eyelids.Decreased tearing or inability to shed tears when crying.Uncomfortable contact lenses.Decreased tolerance to any activity that requires prolonged visual attention.Eye fatigue.
51(continued from previous slide) Treatment optionsUsing artificial tears, prescription eye drops, gels, gel inserts, and ointments.Wearing glasses or sunglasses.Getting punctal plugs.
52Dry Eye What can you do? Use an air cleaner to filter dust Avoid dry conditionsUse lubricating eye dropsVisit an eye care professional